Acute Isolated Utricular Lesion

Woman 66yr with symptoms of acute vestibular syndrome comes three weeks later to our office with complaints of slight instability, oscillopsia and vertigo with abrupt head movements.
No spont Ny, head-impulse neg. positional tests neg.
VHIT, calotic test and cVEMP didn’t show any pathological finding
BUT oVEMP showed left utricular deficit. SVV also confirmed it: -2.7
VNG and MRI excluded any central pathology.
oVEMP utriculus
Conclusion
In this patient acute vestibular syndrome can be ascribed to isolated acute utricular lesion. Lesion of the left utriculus is proven by pathological oVEMP and SVV while other tests showed good function of the semicircular canals and sacculus. Central pathology was excluded by VNG and MRI showing normal findings. We regret we didn’t have an opportunity to record ocular fundus for cyclotorsion.

Patients with acute vestibular syndrome but with good results on VHIT and caloric test should be tested by VEMPs for otolithic function also. Isolated acute utricular lesion might not be so rare cause of acute vestibular syndrome, as it is probably often unrecognized.
Except looking for oculomotor signs in patient with acute vestibular syndrome the attention should be payed to head position as lateropulsion might be a sign of utricular lesion.

Something on this topic:
1. Magliulo G, Iannella G, Gagliardi S, Re M. A 1-year follow-up study with C-VEMPs, O-VEMPs and video head impulse testing in vestibular neuritis. Eur Arch Otorhinolaryngol. 2015;272(11):3277-81.
2. Blödow A, Helbig R, Bloching M, Walther LE. Isolated functional loss of the lateral semicircular canal in vestibular neuritis. HNO. 2013;61(1):46-51.
3. Manzari L, Burgess AM, Curthoys IS. Does unilateral utricular dysfunction cause horizontal spontaneous nystagmus? Eur Arch Otorhinolaryngol. 2012;269(11):2441-5.
4. Manzari L, Burgess AM, MacDougall HG, Curthoys IS. Superior canal dehiscence reveals concomitant unilateral utricular loss (UUL). Acta Otolaryngol. 2015;135(6):557-64.
5. Manzari L, MacDougall HG, Burgess AM, Curthoys IS. Selective otolith dysfunctions objectively verified. J Vestib Res. 2014;24(5-6):365-73.

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